Breast Cancer - Ductal Lavage

One diagnostic technique being studied to detect early stage breast cancer is Ductal Lavage. Ductal lavage was first thought of by George Pappanicolou - since he felt that all breast cancers start in the ductal system, then why not test cells from the ducts for cancer. He tried to extract fluid and cells from the duct but it was difficult and not many other researchers had an interest in what he was trying to do in the 1950s.

20 years later, some other doctors picked up where Pappanicolou had started and began studies of ductal lavage on the west coast. Dr. Pappanicolou was actually the developer of the pap smear test for cervical cancer, so the ductal lavage technique is often referred to as a "pap smear" for the breast.

Now we know that over 95% of breast cancers start in the cells lining the breast ducts and that it can take 8 to 10 years for cells to grow into a 1 cm tumor that can be felt or seen on a mammogram. A ductal lavage (lavage is French for wash or rinse) consists of flushing cells out of the breast duct using suction and a saline wash.

The procedure involves little to no discomfort. A doctor will apply an anesthetic cream that will numb the nipple area. A breast pump is used to determine which 1-2 ducts will be flushed later in the procedure. When the ducts to be flushed have been located, more anesthetic is put in the duct and a catheter is placed. Salt water is flushed through the catheter into the duct and the cells collected to be looked at by a pathologist.

When a pathologist looks at the cells, he or she is looking for abnormalities which could suggest that cancer might develop at a later date. Women may want to consider preventive measures if abnormalities are found to be present in the breast. Those can include careful monitoring with mammography, clinical breast exams and breast self-exams; prophylactic mastectomy (preventive breast removal) for women at very high risk of breast cancer and the use of the drug tamoxifen, an anti-estrogen.

The presence of abnormal or atypical cells in a woman's breast does not mean she will develop breast cancer. Studies show that most atypical cell do not become cancer. Because of those findings, ductal lavage is recommended to be performed only on women who are at high risk for developing breast cancer. That would include women with a strong family or personal history of breast cancer, those who carry the BRCA gene mutations and those who have had non-cancerous conditions from prior biopsies. (Lobular carcinoma in situ or atypical hyperplasia)

The procedure is currently available in a few locations across the US., but as more doctors complete the training for the procedure it will become more widely available. In most cases a woman must meet some eligibility requirements in order to have a ductal lavage performed on their breasts.

Dr. Susan Love is one of the biggest advocates for the procedure in the United States. She feels that ductal lavage can help physicians better understand the development of breast cancer along certain groups of women and in addition, help identify women most likely to develop breast cancer based on hereditary and environmental factors.